Two Cases of Skin Necrosis after Canaliculodacryocystorhinostomy in Young Women

PURPOSE: To report 2 cases of skin necrosis over the medial canthus following canaliculodacryocystorhinostomy in young women diagnosed with canalicular obstruction. CASE SUMMARY: (Case 1) A 31-year-old female presented to our clinic with epiphora in the right eye that had developed 2 years prior. On examination, a right upper and lower canalicular obstruction was noted and the patient underwent canaliculodacryocystorhinostomy with silicone tube intubation. Topical 0.04% mitomycin-C eyedrops were applied twice a day from postoperative day 1 for 7 days. The patient revisited our emergency center with swelling, redness, and tenderness in the medial canthal region that developed 3 days after the initial surgery. Furthermore, a skin ulceration had developed followed by an exudative oozing with crust. (Case 2) A 23-years-old female visited our clinic with epiphora in the right eye that had developed 3 months prior. Ophthalmic examinations revealed a common canalicular obstruction in the right eye and canaliculodacryocystorhinostomy with silicone tube intubation was performed. Seven days postoperatively, the patient developed mild pain and tenderness over the right lacrimal sac and medial canthal erythema with purulent discharge was noted. Furthermore, a localized skin necrosis had developed. CONCLUSIONS: Localized skin necrosis may rarely develop after canaliculodacryocystorhinostomy in young women. If localized skin symptoms develop postoperatively, the patient should be closely monitored.

Results of Silicone Tube Intubation in Patients with Common Canalicular Obstruction in Dacryocystography

PURPOSE: To evaluate the effects of silicone tube intubation in patients showing common canalicular obstruction in dacryocystography. METHODS: We conducted a retrospective chart review of 136 eyes of 93 patients who underwent silicone tube intubation and who were followed for more than 6 months. The patients were divided into 2 groups: the normal canaliculus group (112 eyes of 72 patients) and the common canalicular obstruction group (24 eyes of 21 patients). The demographic characteristics, degree of nasolacrimal duct obstruction on probing, and functional and anatomical success rates of silicone tube intubation were compared between the two groups. Surgery success was noted when the patient was satisfied with the 'improved' tearing symptom and the tear meniscus height decreased. RESULTS: On probing, 17 (70.8%) of 27 eyes revealed definite obstructive feeling at nasolacrimal duct in the common canalicular obstruction group, and there was no significant difference compared to the normal canaliculus group (p = 0.639). The anatomical success rate of silicone tube intubation was 91.1% in the normal canaliculus group and 83.3% in the common canalicular obstruction group, and the functional success rate was 85.7% in the normal canaliculus group and 75.0% in the common canalicular obstruction group. There were no significant differences in success rates between the two groups (p = 0.271, p = 0.161, respectively). CONCLUSIONS: Silicone tube intubation can be considered as a primary treatment option for management of common canalicular obstruction.

Clinical research on the treatment of dacryocystitis combined with canalicular obstruction by dacryocystorhinostomy with canalicular intubation / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigate the clinical efficacy of treatment of dacryocystitis combined with canalicular obstruction by endonasal endoscopic dacryocystorhinostomy with canalicular intubation. METHODS: A total of 27 cases of dacryocystitis combined with canalicular obstruction were treated by endonasal endoscopic dacryocystorhinostomy with canalicular intubation. Canalicular obstruction was treated by laser under dacryoendoscopy and antegrade intubation. RESULTS: For 27 cases, operations were successful, with no complications. All patients were followed up for 6mo, 25 were cured, 2 were effective with no failed. The cure rate was 93%. CONCLUSlON:Treatment of dacryocystitis combined with canalicular obstruction by endonasal endoscopic dacryocystorhinostomy with canalicular intubation has clear field, minimal invasion, quick recovery, exact effect and less recurrence, so it is worthy of promotion.

Surgical Results of Endoscopic Dacryocystorhinostomy and Lacrimal Trephination in Distal or Common Canalicular Obstruction

OBJECTIVES: To evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions. METHODS: The medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The level of obstruction was confirmed by intraoperative probing. The outcome of the surgery was categorized as a complete success, partial success, or failure according to the functional and anatomic patency. RESULTS: The average age of the patients was 52 years. The duration of silicone intubation ranged from 4 to 11 months with an average of 5.7+/-1.6 months. The follow-up period after stent removal ranged from 4 to 15 months with an average of 8.2+/-3.3 months. Complete success was achieved in 25 out of 31 eyes (80.6%), partial success in 4 out of 31 eyes (12.9%), and failure in 2 out of 31 eyes (6.5%). CONCLUSION: Endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stent intubation may be safe and considered as an initial treatment of patients with distal or common canalicular obstructions.

The Effectiveness of Lacrimal Trephination for the Treatment of Canalicular Obstruction

PURPOSE: To determine the effectiveness of lacrimal trephination to treat canalicular obstruction. METHODS: Silicone intubation following lacrimal trephination was performed in 38 eyes of 29 patients with epiphora due to canalicular obstruction between December 2005 and October 2009. Medical records were retrospectively reviewed and telephone interviews were performed. The severity of epiphora was graded by Munk's scale, and anatomical improvement was evaluated by postoperative probing and syringing. RESULTS: The procedure was successful in 73.7% of the cases (grade 0 or 1), and 68.4% of the eyes had complete resolution of epiphora (grade 0). The anatomical success rate was 81.6%. CONCLUSIONS: Lacrimal trephination is a simple and effective treatment for canalicular obstructions. Therefore, lacrimal trephination could be performed prior to attempting an invasive conjunctivodacryocystorhinostomy.

The Result of Canaliculodacryocystorhinostomy with Double Probing in Common Canalicular Obstruction

PURPOSE: To evaluate the results of endoscopic canaliculodacryocystorhinostomy with double probing to resolve common canalicular obstruction. METHODS: A total of 47 patients (56 eyes) with common canalicular obstruction underwent endoscopic canaliculodacryocystorhinostomy. The double probing method was applied to 28 eyes; the remaining 28 eyes were in the control group. The success rate, degree of symptom improvement, and complication rate of the two groups were compared and analyzed. RESULTS: The postoperative success rate was 96% in the group that underwent surgery with the double probing method and 86% in the control group (P=0.160). The rate of symptom improvement without tearing was 86% in the double probing method group and 61% in the control group (P=0.038). Postoperative complication rates such as granuloma formation were 7% and 29% in the study and control groups, respectively (P=0.036). CONCLUSIONS: Endoscopic canaliculodacryocystorhinostomy with double probing to resolve common canalicular obstruction is proven to be effective in enhancing patient satisfaction and lowering complication rates, with no additional costs and risks.

The Surgical Results of Endonasal DCR with Two Silicone Tubes in Common Canalicular Obstruction

PURPOSE: To evaluate the surgical results of endonasal dacrocystorhinostomy with two silicone intubation in common canalicular obstruction. METHODS: Forty patients (57 eyes) who complained of tearing due to common canalicular obstruction underwent endonasal dacryocystorhinostomy. In this study, We randomly divided patients into two groups. One group underwent one-silicone tube intubation (29 eyes, group A) and the other group underwent two-silicone tube intubation (28 eyes, group B). After surgery, we compared the success rates and the causes of surgical failure between the two groups. RESULTS: There were no significant differences between the two groups with regard to age, sex, duration of silicone intubation, or follow-up time. The primary success rates of the group A and the group B were 65.5% (19/29) and 85.7% (24/28) [(P=0.078)], respectively. the final success rates after the revisional surgery were 76.4% (21/29) and 92.8% (26/28) [(P=0.043)] respectively. Primary causes of surgical failure in the group A were: membranous obstruction of the internal ostium (6), common canalicular re-obstruction (2), sump syndrome (1), and functional obstruction (1). The main causes of surgical failure in the group B were: membranous obstruction of the internal ostium (2), and granuloma formation (2). CONCLUSIONS: We believe that endonasal dacryocystorhinostomy with two-silicone tube intubation might be an excellent alternative treatment modality in order to improve success rates in common canalicular obstruction.

Delayed Canaliculoplasty in Unrepaired Canalicular Laceration

PURPOSE: Conjunctivodacryocystorhinostomy with a Jones tube has been the standard treatment for canalicular obstruction secondary to unrepaired canalicular laceration. We sought to evaluate the efficacy of delayed canaliculoplasty with bicanalicular silicone intubation for patients whose canaliculi were not repaired by initial surgery. METHODS: We retrospectively studied the medical records of 4 patients who had bicanalicular obstruction from previous unrepaired canalicular laceration. After careful dissection through the scarred medial canthal region, canaliculoplasty with bicanalicular silicone intubation was performed. The time interval from initial trauma to canaliculoplasty was between 5 months and 10 years. Follow-up periods ranged from 3 weeks to 13 months. RESULTS: All of the canaliculi were reanastmosed. Epiphora disappeared in two, occurred intermittently in one, and persisted in the last at 3 weeks postoperatively. CONCLUSIONS: Delayed canaliculoplasty was functionally effective in three out of four patients. Even though canalicular reconstruction was delayed for a long time, attempting canalicular reconstruction would be recommendable before considering conjunctivodacryocystorhinostomy with a Jones tube.

Ballooning Canaliculoplasty and Silicone Tube Intubation after Lacrimal Trephination

PURPOSE: The purpose of this study was to assess the satety and effectiveness of lacrimal trephination and balloon dilatation in treatment of obstruction of the lacrimal canaliculus. METHODS: Lacrimal trephination and subsequent balloon dilation was performed in 7 eyes of 7 consecutive patients with epiphora due to lacrimal canalicular obstruction and common canalicular obstruction. RESULTS: The average age of patients was 50.3 years old and the average follow-up period was 17.7 months. Anatomical success was 7 of 7 eyes (100%) and functional success , resolution of epiphora was 5 of 7 eyes (71%) CONCLUSIONS: Lacrimal trephination and subsequent ballooning canaliculoplasty in treatment of obstruction of the lacrimal canaliculus seems to be safe and valuable as an primary procedure before Jones tube bypass surgery.

Surgical Results of Modified Dacryocystorhinostomy

PURPOSE: To evaluate the surgical results of endoscopic modified dacryocystorhinostomy (DCR). METHODS: The authors operated on patients with upper punctal and canalicular obstruction associated with nasolacrimal duct obstruction and performed endoscopic modified DCR. One end of a lacrimal tube was passed into the nasal cavity through an excision site of the caruncle and internal ostium and the other end of the tube was inserted into the nasal cavity through a patent punctum and the newly created intranasal ostium. The two ends were tied together in the nasal cavity in modified DCR. RESULTS: The primary success rate of modified DCR was 71.0%. Of the four failed cases, one underwent CDCR using Jones tube. CONCLUSIONS: The author's modified DCR may be a suitable alternative method to CDCR or DCR using monocanalicular silicone tube to relieve epiphora in patients with NLD obstruction associated with upper punctal and canalicular obstruction.

The Results of Endoscopic Canaliculocystodacryorhinostomy with Two Sets of Silicone Tube Intubation in Canalicular Obstruction

PURPOSE: This study evaluated the effectiveness of endoscopic canaliculodacryocystorhinostomy with two sets of silicone tube intubation in the distal part of canalicular obstruction. METHODS: Endoscopic canaliculodacryocystorhinostomy with double silicone tube intubation was done in 26 patients with canalicular obstruction from January 2002 to December 2002. Probing or trephination was used for recanaliculization of obstructed canaliculi. The silicone tube was left in place for 6 months. RESULTS: The success rate was 76.9% (20 of 26 patients) two months after tube removal. The level of canalicular obstruction or method of bougienage did not affect the success rates. Complications includes granuloma formation (12), synechia of ostium (1), prolepses of tube (2), and acute dacryocystitis(1). CONCLUSIONS: Endoscopic canaliculodacryocystorhinostomy with double silicone tube intubation showed a relatively high success rate and was more effective and convenient than conjunctivodacryocystorhinostomy with Jones tube.

Canalicular Trephination with Lacrimal Trephine and Endoscopic DCR

PURPOSE: The purpose of this study is to evaluate surgical outcomes of canalicular trephination with lacrimal trephine and endoscopic dacryocystorhinostomy in patiens with common canalicular or canalicular obstruction. METHODS: 35 patients (38 eyes) diagnosed as common canalicular or canalicular obstruction undergoing surgery between December 1999 and August 2003. Patients have been followed up more than 5 months after surgery. RESULTS: The average age of patients was 57.3 years old and the average follow-up period was 7.1 months. The overall success rate was 92.1%. With obstructions within lower canaliculus, the success rate was 75.0%. The success rate of the cases with obstructions within upper canaliculus and upper and lower canaliculus was 100%, and the success rate of the cases with obstructions within common canaliculus was 95.2%. CONCLUSIONS: The surgical success rate of canalicular trephination with lacrimal trephine and endonasal dacryocystorhinostomy was better than canaliculodacryocystorhinostomy and this seems to be adequate as an primary procedure before Jones tube bypass surgery.

A Survey of Post-Operative Satisfaction in Patients with Canalicular Obstruction after Jones Tube Intubation

PURPOSE: This study was devised to evaluate the post-operative satisfaction and daily life behavior in the patient who underwent Jone tube intubation. METHODS: 60 patients who underwent Jones tube intubation replied to the questionaire consisted of twenty questions. The questionare consisted of six groups: Basic statistical informations, past medical history, post operative satisfaction, post operative complications, questions about anesthesia, patients compliance. RESULTS: 28 (46.7%) patients were satisfied with outcomes of Jones tube intubation. 9 (15.0%) patients replied acceptable, and 23 (38.3%) patients were dissatisfied. Age, sex were not significantly associated with the post operative satisfaction (P-value>0.05). Air blowing in the eye was the most frequent complications (41.6%) and other concerning ocular symptoms are regurgitation of nasal discharge (35.0%), persistent tearing (35.0%), fogging of eyeglasses (18.3%) and etc. 23 patients (46.0%) refused to receive bilateral surgery because of post operative complications, old age, economic problems. CONCLUSIONS: Post operative satisfaction after Jones tube intubation is not associated with its functional success rate due to numerous postoperative complications.

Silicone Intubation for Canalicular or Common Canalicular Obstruction in Adult

PURPOSE: Patients with canalicular or common canalicular obstruction have been treated by carrying out conjuctivodacryocystorhinostomy mainly through skin or the nasal cavity, but all sorts of defects attendant on an operation have been indicated. At this, the authors inquired into a result of a surgery and their satisfaction in a different viewpoint for silicone intubation. METHODS: We inquired into a result of a surgery and their satisfaction in a different viewpoint for 68 patients' 72 eyes who can be observed over 3 months among patients diagnosed as canalicular or common canalicular obstruction and operated on with silicone intubation as subject. RESULTS: After surgery, silicone tube was removed at average postoperative 5.8 months and we observed them for average 10.5 months. The result of operations showed that successful cases are 72.2% (52 eyes) and failing cases are 28.8% (20 eyes). CONCLUSION: For the cases with canalicular obstruction, especially common canalicular obstruction for short period, primary silicone intubation would be one of the ideal lacrimal surgery that should be explained the possible secondary conjuctivodacryocystorhinostomy later.

Canaliculodacryocystorhinostomy in Canalicular Obstruction

The authors performed canaliculodacryocystorhinostomy using operating microscope to resect canalicular obstruction area and reconstruct the excretory system with silicone tube insertion in patients with epiphora due to canalicular obstruction. We performed 50 operations on 44 patients with canalicular obstruction from March 1994 to December 1998. The average age of patients was 56.4 years old and the average follow-up period was 7.2 months. The canalicular obstruction site was as follows :medial common canalicular area was 13 eyes, lateral common canalicular area 20 eyes, lower canalicular area 11 eyes and upper and lower canalicular area 6 eyes. The surgical success rate was 78%. Thus authors conclude that canaliculodacryocystorhinostomy can reduce complications of a Jones tube and one can expect the physiological drainage of tears through reconstructed canaliculus.

Treatment of Common Canalicular Obstruction Using Lacrimal Trephine

Conjunctivodacryocystorhinostom.y using Jones tube has been the treatment of choice for patients with epiphora due to common canalicular obstruction. But this procedure carries a lot of disadvantages including external scar formation and many complications result from general anesthesia, and necessity of permanent prosthesis and long-term follow-up. So authors have used a new instrument, the lacrimal trephine designed for creating an opening through 8 distally occluded lacrimal canaliculus to treat the common canalicular obstruction. From June 1996 to December 1996, we performed 8 lacrirnal trephination with silicone tube insertion in five patients diagnosed as common canalicu-lar obstruction. All of them have achieved the anatomical success and four of thein have shown clinical success.

Tear Drainage through the Upper Can,liculus in Case of Lower Canalicular ObstruCtion

Symptomatic epiphora has been rarely observed in patients jwith only one canaliculus obstruction. The authors experienced 7 cases of only lower canahculus obstruction without epiphora. Tear drainge of these eyes was assessed using dacryoscintigraphy and compared with the comtrol eyes. The measurement of T1/2 valuse, the duration of which a given amount of 99m-Tc-phytate drops to half in the conjunctival fornix was performed. The T1/2 valuse was 368.1 seconds in average in the eye with the lower canaliculus obstruction and 263.3 seconds in the control eyes(p